MEDICATION ADMNISTRATION

DRUG - Natural or synthetic substance (when taken in to living body) affects

its functioning or structure and is used in the diagnosis, mitigation, treatment
or prevention of a disease or relieve discomfort.
FORMS OF MEDICATION
Drugs are available in various forms such as tablets, capsules and
suppositories.
1. SOLID FORM
Caplet - shaped like a capsule and coated for ease of swallowing.
Capsule medication in powder, liquid or oil form and encased
by a gelatin shell.
Enteric coated tablet tablet for oral use coated with materials
that do not dissolve in stomach. Coating dissolves in intestine,
where medication is absorbed.
Pills tablets containing one or more drugs shaped in to
globules, ovoid or oblong.
Tablet powdered dosage from compressed in to hard disks.
Troche (Lozenge) flat, round dosage from containing drug,
flavoring, sugar and mucilage, dissolves in mouth to release
drug.
Suppository solid dosage form mixed with gelatin and shaped in
the form of pellet for insertion in to body cavity. (Rectum or
vagina), melts when it reaches body temperature, releasing
drugs for absorption.
2. LIQUID FORM
Injections for IM/IV
Drops for eye, ear, nose
Elixir clear fluid containing water and / alcohol, usually has
sweetener added for ease of swallowing.
Syrups medication dissolved in a concentrated sugar solution,
may contain flavoring to make the drug more palatable.
Suspension finely divided drug particles dispersed in a liquid
medium, when suspension is left standing, particles settle to the
bottom of the container.
Lotion drug in liquid suspension applied externally to protect
skin.
Tincture- alcohol or water drug solution.
Emulsions mixture of two immiscible liquids uniformly
dispersed in the form of very small globules throughout each
other.
3. SEMI SOLID FORM

Ointment Externally applied preparation usually containing one

or more drugs.
Paste semi solid preparation, thicker and stiffer than ointment,
absorbed through skin more slowly than ointment.
Cream a non greasy solid preparation used on the skin.

ABBREVIATIONS

a.c. before food/ meals

p.c after food/ meals
b.d. twice a day
t.i.d. t.d.s. three times a day
h.s. at bed time
h.n. tonight
o.n. each night
o.d. each day
o.m. each morning
c.m. tomorrow morning/ coming morning
p.r.n. when needed
s.o.s if necessary in emergency
stat at once
mist mixture
pulv powder
q.i.d four times a day
q every
Q6H every 6 hours
Q8HH every 8 hourly
Qhs every night at bed time
PO per oral
Susp suspension
Rx treatment/ prescription
C with
Inj. injection
IM intramuscular
IV intravenous
SC subcutaneous
Cap. capsule
Ad. Lib. freely, as desired

 Elix elixir
MEASURING UNITS
1. Gram g
2. Curie ci
3. Deciliter dl
4. International unit iU
5. Kilogram kg
6. Liter L
7. Micro curie uCi
8. Microgram ug
9. Micro liter uL
10.
Micromole umol
11.
Micron um
12.
Milli curie -

ORAL MEDICATION
INTRODUCTION- The route prescribed for administering a medication
depends on medications properties and desired effect and on the client
physical and mental condition. The oral route is easiest and the most
commonly used. Medications are given by mouth and swallowed with the
fluid. Oral medications have a slower onset of action and a more prolonged
effect than parental medication. Clients generally prefer oral route.
DEFINITION- administration of medicine through mouth for prophylactic and
therapeutic effects.
PURPOSES- 1. To promote health Drugs are given to the client to increase
their resistance to diseases and to meet the deficiencies.
E.g. iron supplementation, vitamins etc.
2. To prevent illness.
3. To help in diagnosis. E.g. barium used in X ray.
4. To alleviate illness: certain drugs for symptomatic pain relief. E.g.
analgesics
5. Therapeutic purpose. E.g. antibiotic for infection.
CONTRAINDICATIONS

For unconscious patients.

For uncooperative patient.
After oral and gastric surgery.
Oral cancer.
Before diagnostic tests and operations.

GENERAL INSTRUCCTIONS

1. Before administration (during preparation of drug)

Identify the patient by checking the medication card.
Check the physicians order BEFORE PREPARING THE DRUGS.
Check the label of the containers trice before preparing the drug.
Before the medication container is taken from the shelf.
Before pouring the drug.
Before replacing the container in shelf.
Check the expiry date of the drug.
Always use a calibrated measure while preparing the drug.
Shake the liquid medicine before pouring it in to the ounce glass;
pour it away from the label.
Wipe the mouth of the bottle, close it tightly and replace it at the
proper place.
Hold the ounce glass at the eye level and place the thumb on the
neck of the ounce glass to which medicine is to be poured. Read
the lower level of the meniscus in the ounce glass.
When taking tablets or capsules do not touch them with hands,
drop them from the container to its lid and then to the medication
cup.
Do not put back the medicine once it is taken out of the container.
Do not use the medicine if there is a change in color, odor or
consistency.
Prepare the drugs just before the time of administration and do not
leave the drug in the medicine tray without proper identification.
2. During administration
Observe the ten rights of administration of drugs.
RIGHT PATIENT regarding to the right patient to be
administered a medicine.
RIGHT MEDICATION regarding to the right medication to be
administered to a patient.
RIGHT DOSAGE right and enough dose.
RIGHT ROUTE Medication should take on its real time matter of
way. (if must to be taken oral, it should be taken orally).
RIGHT TIME should be according to right time. (if it should be
taken by 7 in the morning, it should be taken on 7 in the
morning).
RIGHT DOCUMENTATION right input of information, data and
details.
RIGHT CLIENT EDUCATION RIGHT HEALTH EDUCATION.
RIGHT TO REFUSE right to refuse medication.
RIGHT ASSESSMENT right to determine real illness.
RIGHT EVALUATION right examination and right judgment.
3. After administration
Record only the medicine, which you have administered.
Record the date, time, name and dose of the drug administered.
Never record a medicine before it is given.

 Record the effect observed the local or systematic effect, its

side effect or toxicity, any complication.
PREPARATION OF THE PATIENT
Explain the procedure.
Check the identification of the patient.
Check the diagnosis and age of the patient.
Be sure of the purpose of giving medication.
Check the nurses record when the last dose was given.
Check for any contraindication before giving the medication.
Check the nature and method of administration of the drug.
Check that the patient is able to swallow.
Assist the patient to a sitting position, if possible.
Protect the patients clothing with a towel.
PREPARATION OF THE ARTICLES
A tray containing
Towel to protect the patients clothing
A medicine glass (ounce glass) , a teaspoon or a droper to measure
the medicine
A glass of drinking water or water in a feeding cup to swallow the
medicine
A duster or towel to wipe the outside of the bottle
Mortar and pestle to crush or powder the tablet, if necessary.
A kidney tray and paper bag to discard the waste.
A medicine card to write the medication prescribed for the patient.
MEDICATION CARD
NAME:
AGE:
SEX:

BED NO.:
WARD NO:
DIAGNOSIS:
OPERATION

PERFORMED:
[Link]. MEDICINE
1
Tab. B
complex
2
Inj.
ampicillin

ROUTE
Oral

DOSE
1

FREQUENCY
BD

TIME
8-8

IM

500mg

Q6H

10-4/10-4

NURSING ORDER
Steam inhalation:
Intake output chart:
Change of dressing every day:
Change of position every hourly:
Urine testing for suger:

DIET
Diabetic diet:
Low sodium diet:
Normal diet:
PROCEDURE

PROCEDURE
S.N
O.
1
2
3
4
5

6
7
8
9

STEPS
Wash hands with soap and water.
Read the physicians prescription
and enter it in the medicine card.
Make sure that all the medicines
are entered correctly.
Take out the medicine from the
shelf after reading the medicine
card.
Check the medicine table thrice,
check the expiry date of the
medicine.
Take out the medicine as follows
Take out tablets or capsule
from the bottle in to the lid
of the container first.
Do not touch with hands.
Pour syrups from the side of
the bottle away from the
label. Do not pour an excess
amount.
Wipe the mouth of the bottle with
a clean duster and close it tightly.

RATIONAL
Reduce transfer of microorganisms from
hands to medication.
For giving a correct dose to the patient at
the right time, for convenient
administration by staff and students.
To check the possibility of pouring a wrong
medicine.
To ensure the right and valid medicine.
To get the required number of tablets or
capsules. If it comes extra, it may be
poured back in the bottle container. To
prevent contamination pouring from the
side of the bottle prevents spoiling of the
label.

Wiping keeps the bottle clean it avoids

contamination of drugs.
To prevent mistakes in giving drugs.

Place the card with medicine on

the tray.
To prevent error which may occur.

10
11
12
13

Take the tray to the bed side.

Identify the patient.
By calling out his name.
Ask the patient to repeat his
name.
Verify identification with the
nurse
Record and medication card.

For easy administration and absorption.

Give proper position.

Staying with the patient will ensure that he

has taken the medicine.

Administer the medicine.

Helps in swallowing the solid medicine.

Stay with the patient until he has

swallowed the medicine.
Provide water for drinking after
the medicine is administered.

RECORDING AND REPORTING- record administration of oral medication

on MAR placing nurses initials or signature.

Record the reason any drug is withheld and follow agencys policy for
proper recording.

PATIENT AND FAMILY TEACHING- following points should be taught to

the patient about each prescribed medicines-

Why the drug is prescribed and what is supposed to do.

How long it will be before results of the drugs will be evident.
Signs and symptoms of adverse effects to be observed for and what
to report to the physicians.
The dosage and schedule for taking the drugs.
Reason for taking for the drug as schedued.
What to do if a dose is accidentally forgotten.
How to deal with common side effects.
Whether the drug should be taken with food.
The physician should consulted before the patient takes any over the
counter drugs.
The amount of fluid that the patient should drink while taking the drug.
The importance of periodic laboratory work if it is recommended.
Food that should be avoided while, taking the drug.

CONCLUSION- the oral medication gives safe, effective, and economical

route for administering medications. It provides sustained drug action with
minimal discomfort. Administering medication by oral route requires problem
solving and knowledge application unique to professional nursing.

SUBLINGUAL MEDICATION
INTRODUCTION- Sublingual medications are orally disintegrating or
dissolving medications that are administered by being placed under the
tongue. These medications are transferred to the bloodstream from the
mucous membranes in the mouth after dissolving, allowing for quick
absorption that avoids the loss of potency which may come with first-pass
metabolism in the stomach and liver. Doctors may recommend sublingual
medications to treat certain conditions, or if a patient has trouble swallowing
or digesting medication.
DEFINITION- Sublingual and buccal medication administration is a way of
giving someone medicine orally (by mouth). Sublingual administration is
when medication is placed under the tongue to be absorbed by the body. The
word sublingual means under the tongue.
PURPOSES- there is a need for the medication to be absorbed rapidly.
STEPS OF PROCEDURE
S.
NO
.
1
2
3
4
5
6

STEPS

Wash hands.
Prepare medication, adhering to
14 rights of drug administration.
Identify client by reading
identification bracelet and
addressing client by name.
Explain procedure and purpose
of drug.
Verify allergies listed on
medication record or card.

RATIONAL

Reduces risk for infection.

Decreases chance of drug errors.
Confirms identity of client.
Decreases anxiety, promotes
cooperation.

Decrease nurses exposure to

Done gloves.

Place tablet Under tongue for

sublingual medication.
Between check and gum
on either side of mouth for
buccal administration
(avoid broken or irritated
area).
Note if clients mucous
membranes are dry, offer a sip
of water before giving
medication.
Instruct client not to swallow
drug but to let drug dissolve.
Discard gloves and wash hands.
Document administration on
medication record.

9
10

clients body secretions.

Reduces additional irritation.

Facilitates absorption by proper

route.
Reduces transfer of microorganisms.
Serves as legal record of medication
administration and prevents
accidental re medication.

WARNINGS- do not attempt to take any medication sublingually that was not
prescribed as such.
Some medications require digestive actin to absorb and may be effective or
even harmful if taken sublingually.
DOCUMENTATION- The following should be noted on the clients chart.
1. Name, amount and route of drug given.
2. Purpose of administration if drug is given on a when needed (p.r.n)
basis.
3. Assessment data relevant to purpose of medication.
4. Effects of medication on client.
5. Teaching of information about drug used or about self administration of
medication.

ADMINISTRATION OF PARENTERAL MEDICINE

INTRODUCTION- administration of parenteral medicine is an invasive
procedure and it must be performed under a strict aseptic technique.
Parenteral medicine can be administered in the body by the subcutaneous,
intra muscular, intra dermal and intravenous route. Each type of injection
requires certain skill so that the medicine reaches its proper location. The
effect of parenteral medicine administered may develop rapidly depending
on the rate of drug absorption.
DEFINITION- Parenteral administration involves giving drug by a route
throgh injection into the body tissue.
PURPOSE- to get a rapid and systemic effect of drug.
To obtain maximum effect of the drug even when the patient is
unconscious, unable to swallow due to neurological or surgical
ilteration affecting the throat and mouth or when the patient is
uncooperative.
Some medicines that can not be administered orally due to poor
absorption in GI tract.
When the drug is toxic and irritating to the gastrointestinal mucosa.
To obtain a local effect at the site of the injection eg. Local anesthesia,
diagnostic tests (tuberculin test), sensitivity test, local therapeutic
effect.
To restore blood volume by replacing the fluid eg. In shock.

TYPES OF INJECTION
INTRA-DERMAL- when medicines are introduced in to the dermis.
HYPODERMAL OR SUBCUTAANEOUS- when medicines are introduced in to the
subcutaneous or areolar tissue (just below skin).
INTRAMUSCULAR- when medicines are introduced in to the muscles.
INTRAVENOUS- when medicines and fluids are introduced in to a vein.
INTRAARTERIAL- when medicines and fluids are introduced in to a artery.
INTRASPINAL OR INTRATHECAL- - when medicines and fluids are introduced
in to the spinal cavity.
INTRAOSSEOUS- when medicines and fluids are introduced in to the bone
marrow.
INTRAPERITONEAL- when medicines are introduced in to peritoneal cavity.
INFUSION- when large quantities of medicines or fluids are introduced in to
the body.
COMPLICATIONS OF INJECTIONS

Infection
Pyrogenic reaction
Allergic reaction
Tissue trauma
Pain/swelling
Foot drop
Air embolism
SYRINGES AND NEEDLES
A variety of syringes and needles are available to deliver a certain
volume of drug to a specific type of tissue.
1. Syringes- Syringes consist of a cylindrical barrel with the tip
designed to fit the hub of hypodermic needle and with a close fitting

plunger

Syringes are available in various sizes 1,2,5,10,20, and 50ml.

syringes may be of two materials GLASS SYRENGES

Advantages- the markings are accurate and therefore exact quantity can be
drawn.
-

The fluid level can be clearly seen as the glass is

transparent.
- They can be easily sterilized by boiling and reused.
- Glass syringes are resistance to punctures.
Disadvantages- glass syringes can break.
- They carry a greater risk of air embolism because they are
rigid.
-they are more expensive. Glass syringes are no more prefered because the
risk of spreading dangerous disease like AIDS when not properly sterilized.

PLASTIC SYRINGES

Advantages- Plastic syringe do not break easily.

-

Because they are collapsible, they allow proper emptying

of the syringe, hence less risk of air embolism.
- They are cheaper.
- They are disposable.
Disadvantages- plastic syringes are not very accurate in
scale.
- They can not be easily sterilized.
- They can not be reused.
SPECIAL SYRINGES
- Insulin syringe has marking in units40 in 1 ml (red) or 80 in
1 ml (green) are suitable for administration of insulin.
- Tuberculin syringe is a syringe of 1 ml capacity with0.01 ml
markings. It is useful for administration of very small
volume.
- Sterile disposable syringes are made of plastic and are
packed with a needle to be fixed at the time of use.

Advantages- need no sterilization.

-

Injections are less painful as needle is sharp.

Convenient to use.

Disadvantage- works outcostlier as they are not reusable

2. Needles- needles come packed in individual sheets to allow
flexibility in choosing the right needle. Most of the needles are made
of stainless steel and are of different sizes, which is rust proof. The
tip which is at the end of the shaft is beveled. The bevelling may be
short, very short or regular. Needle is available in different gauge
thickness and length. The gauge numbers are from 13 (thickest) to
27 (finest). Depending on the route of administration, size of the

patient and the thickness of the solutions to be injected, the needle

is selected.

3. The needle has three parts- Hub- which fits on the syringe
- Shaft- which connects the hub
- Bevel- slanted tip
4. Criteria for selection of syringe and needles
The route prescribed
Viscosity of medicine
Amount of medicine to be administered
Body size and amount of safety tissue.
SITES FOR GIVING INJECTIONS
1. INTRAMUSCULAR INJECTION
[Link] muscle
B . Ventro gluteal muscle

C. Dorso gluteal
D. Vastus lateralis

2. SUBCUTANEOUS INJECTION- the best size for giving a subcutaneous

injection includes vascular areas around the outer aspect of the
upper arm, the abdomen from below the costal margin of iliac crest
and the anterior aspect of the thigh. These areas are easily
accessible.
Outer sites include the scapular areas of the upper back and upper
ventral or dorsal gluteal areas.
No injection sites should be used for more than 6-7 weeks.

3. INTRADERMAL INJECTION- intra dermal injections are given mostly

for skin testing (tuberculin test and allergic test). The medicines are
injected in to the dermis where blood supply is reduced and drug
absorption occurs slowly. The inner forearm and upper back are the
ideal locations.
GENERAL INSTRUCTIONS TO BE KEPT IN MIND

Injection should be given after doctors prescription.

Strict aseptic technique to be followed in the sterilization of equipment,
in the preparation of medication, in the administration of injection.
Syringes and needles used for injections should be kept separately
from those which are used for other purposes.
Syringes should be airtight.
A needle should be sharp and patent.
Change the needle after withdrawing the medicine from the rubber
stopper container, before giving injection to the patient.
Observe 10 rights of administration of medicines.
Never use a drug whose expiry date is over.
Always make the patient relaxed and give him a comfortable position
while giving injections.

Always give a test dose before administration of all types of serum,

and certain antibiotics such as penicillin etc. to rule out an allergic
reaction.
Never inject any air while giving injection.
Select the appropriate site.
Rotate the site of injection to prevent tissue fibrosis.
Use the correct technique for giving injection.
After injecting always with draw the needle to make sure that it is not
in a blood vessel in case intra muscular and subcutaneous injections. If
there is the presence of blood in the syringe withdraw the needle and
select another site for the injection.
Massage the area at the site of injection expect in case of intra dermal
injection.
Injection should be charted and signed immediately after it is
administered by the nurse.
Observe for any reaction of drugs after administration.

INTRAMUSCULAR INJECTION

DEFINITION- it is the administration of injection in to the deep muscle

tissue. When irritating preparations are given intra muscularly, the Z track
method of injection is used to minimize tissue irritation by sealing the drug
within muscle tissue.
PURPOSES- 1. To administer medication deeply in to muscle tissue, without
injury to the patient.
2. to administer a medication with absorption and onset of action quicker
than the oral route and that may be irritating to the subcutaneous tissues.
3. to obtain a local effect at the site of injection as local anesthetics.
ASSESSMENT OF THE PATIENT- review physicians medication order.

Know information regarding expected action of the drug.

Consider factors that contraindicate intra muscular injection.
Assess indications for intra muscular injection.
Assess clients medical history, history of allergies and medication
history.
Consider clients age.
Assess clients knowledge regarding medication and dosage schedule.
Observe clients verbal and non verbal response towards receiving
injection.

NURSING OBJECTIVE-1. Develop individualized goals for the client

based on nursing diagnosis.
2. Minimize the discomfort of the patient.
3. Minimize the clients anxiety.
PATIENT PREPARATION- 1. Explain the procedure to the patient.
2. Provide privacy, if needed.
3. Restrain the site of injection in case of children.
4. As for as possible avoid meal time.
5. Divert the attention of the patient away from the injection by friendly
conversation.
6. Offer bad pan if client has to remain in bed for a considerable time
before, during and after the procedure.
7. Place patient in comfortable and relaxed position.
EQUIPMENTS- A tray containing

Disposable syringes and needles of various size according to the

need in a covered tray.
Transfer forceps in a jar containing antiseptic solution.
Sterile cotton swab and gauze pieces in sterile container.
Methylated spirit in a container
Bowl with water (as per hospital policy)
Kidney tray with paper bag
Drug ordered
Water for injection
File to cut ampoule
Small covered sterile tray
PROCEDURE

S.N
O.
1

Wash hands.

Reduces transfer of microorganisms.

Close room curtain or door.

To provide privacy.

Keep linen or gown draped over

body parts not requiring exposure.
Select appropriate injection site by
assessing size and integrity of
muscle. Palpate for areas of
tenderness or hardness. Note
presence of bruising or area of
infection.

To visualize the injection site.

6
7
8

STEPS

Assist client to comfortable position

depending upon the site chosen.
Vastus laterals- client lies flat,
supine with knees flexed.
Ventro gluteal- client lies side
or back, flexes knee and hip
on side to be injected.
Dorso gluteal- client lies
prone with feet turned inward
or lies on side with upper
knee and hip flexed and
placed in front of lower leg.
Deltoid region- client may sit
or lie flat with lower arm
flexed but relaxed across
abdomen or lap.
Relocate site using anatomical land

RATIONAL

Muscle should be soft when relaxed and

firm when tensed indicates healthy
tissue.

Position that reduces strain on muscle

minimizes discomfort of injection.

Injection in to correct anatomic site

prevents injury to nerves, bones and
blood vessels.
Children often jerk or pull away
unexpectedly causing injury to
themselves.

marks.

10

Restrain child

11

Cleanse site with an antiseptic

swab. Apply swab at centre of the
site and rotate, outward in a
circular direction for about 5 cm.
Hold swab between third and fourth
finger of non dominant hand.
Remove needle cap or sheath from
needle by pulling it straight off.
Hold syringe between thumb and
forefinger of dominant hand as if
holding a pen. Hold it down at 90
degree angle.

Swab remains readily accessible for

when needle is withdrawn.
Prevents needle from touching sides of
cap thus prevents contamination.
Quick, smooth injection requires proper
manipulation of syringe. Needle must be
injected at 90 degree angle to enter
muscle and so air lock rises to top of
medication towards plunger.

Administer injection
Position non dominant hand
at proper anatomic land
marks and spread skin tightly.
Children and adults- inject
needle quickly 45 degree
angle in to muscle.
New born- inject needle
quickly 45 degree angle.
Pointed towards the knees.
If client muscle mass is very
small, grasp body of muscle
between thumb and finger.
If irritating preparations are to
be given use Z track
technique.

Ensures that medications reach muscle

mass

12

13

14

15

16
17
18

After needle enters site, grasp

between lower ends of syringe
barrel with non dominant hand to
end of plunger. Avoid moving
syringe.
If using Z track method hold skin
tightly with non dominant hand.
Use dominant hand to move
carefully towards end of plunger.
Slowly pull back on plunger to

Mechanical action of swab removes

secretions containing microorganisms.

Speeds insertion and discomfort

Ensures that medication reaches muscle

mass.
Creates zigzag path through tissues that
seals needle track to avoid tracking of
medication.
Smooth manipulation of syringe parts
reduces discomfort from needle
movement.
Skin must remain pulled until after drug
is injected.

Aspirate of blood in to syringe indicates

intra venous placement of needle. Intra
muscular injections should be given slow
to reduce pain and tissue trauma.

19

aspirate medication. If blood

appears in syringe, remove needle
and dispose off medication and
syringe properly. Repeat
preparation procedure. If no blood
inject medication slowly.
Withdraw needle quickly while
placing antiseptic swab gently
above or over injection site.
When using Z track method, keep
needle inserted for 10 seconds after
injecting medication. Then release
clients skin after withdrawing
needle.
Massage skin lightly. In children,
place small band aid over puncture
site.
Assist client to comfortable
position.
Discard unwrapped needle or
needle enclosed in safety shield
and attached syringe in to
appropriate labeled receptacles.
Remove gloves and wash hands.

Support of tissue around injection site

minimizes discomfort during needle
withdrawal.
Allows medication to dispense evenly.
Tissue planes slides across one another
to create zigzag path that seals
medication in to muscle tissue.
Massage can stimulate circulation and
improve drug distribution. Band aid
prevent bleeding.
Gives client sense of well being.
Prevents injury to client and health
personal. Needles should not be
recapped before disposal.
Educes transmission of microorganisms.

OBSERVATION- Return to room and ask if client feels any acute pain,
burning, numbness or tingling at injection site.

Return to evaluate clients response of medication in 10-30 minutes.

Ask client to explain purpose and effects of medication.

RECORDING- immediately after medication chart the type, dose, route, date
and time of medication administered in medication record.

Report any undesirable effect from medication to nurse in charge or

physician.
Record clients response to medication.

PATIENT AND FAMILY TEACHING- 1. Client requiring, regular injections

should learn importance of rotating sites. Teach family members the
technique of administering drug.
2. Instruct them to maintain sterile technique.
3. Instruct them to observe for medication side effect.
4. Allow for several return demonstrations.

5. Teach proper method of disposal of needles and equipment.

INTRAVENOUS INJECTION
INTRODUCTION- injections are parenteral therapy. It means giving of
therapeutic agents including food outside the alimentary tract is forcing of a
fluid in to a cavity, a blood vessel or body tissue through a hollow tube or
needle. Each injection route is unique in regard to the type of tissue in to
which the medication is injected. The characteristic of tissue influence rate of
medication. The nurse should know the volume of the medication to
administer, the medication characteristics, viscosity and the location of
anatomical structures underlying injection sites.
DEFINITION- intravenous injection means the introduction of a concentrated
dose of medication directly in to the systemic circulation in small amount. It
is injection of a bolusor a small volume of medication through an exixting IV
infusion line or heparin lock.
PURPOSES- the main purpose to administer medicine.
In emergencies a fast acting drug must be delivered quickly through IV
route.
The administration of IV route cause less discomfort.
To prevent and treat shock and collapse.
To meet patients basic requirments for calories, water ,minerals and
vitamins.
To supply the body adequate amount of fluid when patient is not able
to take by mouth.
Through IV route therapeutic blood levels can be established.
ASSESSMENT OF PATIENT- review clients medical record for physicians
order stating type and amount of IV fluid.

Obtain information from drug reference book or pharmacist concerning the

composition, purpose for administration and side effect to expect.
Determine the client understanding of reason for IV fluid.
Determine the presence of any factor that increases the clients risk for
development of complication i.e. very young,very old client, presence of heart
failure or renal failure.

NURSING OBJECTVES- Provide privacy to the client.

Ensure client position is not contraindicated by medical condition.

Nurse take special care to avoid errors in dosage calculation and
preparation.
Nurse should check vital signs before and after infusion.
Do not use an area, which shws signs of infection.
Injections should be free of abnormalities that may interfere with
medical absorption.
Do not use the same site repeatedly because site becomes hardend.

PATIENT PREPARATION- explain the procedure to the patient to win his

confidence.
Tacfully send the visitors out of patients room.
If the general condition allows ask the patient to wash hands with soap
and water.
Restrain the site in case of children.
Check the vital signs and record it in nurses record for future
reference.
Divert the attentin of patient away from the infusion.
Adjust height of bed for comfortable working of nurse.
Select the height on non dominant arm to give maximum freedom for
the patient.
Place the mackintosh and towel under the area where the infusion is
started.
Provide privacy if necessary.
Place the patient in a comfortable and relaxed position suitble for
infusion site.
PREPARATION OF ARTICLES
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.
1

ARTICLES
A tray containing
Sterile syringes and needles of various
sizes

2
3

Sterle cotton swabs/gauze pieces in a

sterile container

PURPOSE

To deliver a certain volume of drugs

depending on the route of
administration
To clean the site before giving
injection

A bowl with water and an antiseptic

solution

Sterile water for injection

To rinse the glass syringes, needles

and to put the disposable syringes
To dissolve powder form of drugs

Drug ordered

To administer drug to the patient

Ampule file

A kidney tray and paper bag

To cut and open the ampule and

open the vial
To dispose of used swabs, ampules
and vials

9
10

A mackintosh and towel

11

To protect the bed

Tourniquet
Knife dish (sterile small covered tray)
Adhesive plaster and scissors

To prepare the vein for IV injection

To carry the prepared medicine to
the patient.
To secure the needle in case of
injection is to be repeated.

PROCEDURE
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STEPS
.
1
Wash hands, apply gloves.
2

Check physicians order for the type

of medication, dosage and route.
Preparation of medicine from
ampoule
Tap top of the ampule lightly
and quickly with fingers until
fluid leaves te neck.
Place a small gauge piece or
swab against the neck of the
ampoule.
File the neck of the ampule
and snap the neck quickly
and firmly away from hands.
Insert the syringe needle in to
the centre of the ampoule.
(do not let the needle tip or
shaft touch the rim of

RATIONAL
Reduces transmission of
microorganisms.
Ensures safe and accurate drug
administration.

Dislodge the fluid that collects above

the neck so that all medicines move in
to the lower chamber.
Protects the fingers of the nurse from
trauma.
Prevents shafting of glass toward the
nurse or in to the ampule.
Outside of the rim of the ampoule is
unsterile.

ampoule).
Aspirate the medicines from
the ampoule by pulling back
the piston gently.
If air bubbles are aspirated,
do not expel air in to the
ampoule.
To expell theexcess of air
bubbles, remove the needle
from ampule and hold it
pointing upward.
Change the needle and place
the syringe in the knife dish.

Preparation of medicine from

vial
Remove the metal cap
covering the vial with a file.
Wipe off the surface of the
vial with a spirit swab.
Take syringe and withdraw
the amount of solvent
required to dissolve the
medicine (eg. Medicine is in
powder form)
Take syringe with needle and
pull back the piston to draw
an amount f air in to the
syringe equivalent to the
volume of medication to be
aspired from the vial.
Insert the tip of the needle
into the rubber cap of the
vial. (apply pressure while
doing needle insertion).
Inject air in to the vial.
Invert vial and withdraw the
required amount of medicine
by holding the vial between
the thumb and middle finger
of the non dominant hand
and grasp the syringe with
the dominant hand.
Push the air in to the vial.

Withdrawal of piston creates a negative

pressure and helps in the aspiration of
medicine in to the syringe.
Air pressure will force the fluid out of
the ampoule and the medicine will be
lost.
Holding the syringe vertically will make
the medicine come down and air
upward and expel the air by pushing
back the piston upwrd.
To controll the transmission of infection.

To expose the rubber seal. Remove

dust and prevent infection.
To dissolve the medicine.

To acilitate withdrawal of mfedicine

from the vial
As air helps to prevent building up of
negative pressure in the vial.
Centre of the seal is thinner and easier
to penetrate.

To facilitate easy withdrawal of the

medicines.
Inverting vial allows fluid to settle
in the lower vial.
Position of hands allows easy
manipulation of hands.

To facilitate easy flow of medicine.

Pull back the piston to take

out the required medicine
and remove the syringe.
Change the needle and keep
the syringe in the knife dish.
Replace the vial in a kidney
tray and the used needle in
the puncture proof container.

Administration of injection
Check the medicine ordered.
Explanation to the patient
Wash hands and wear gloves
Identify the client again by
asking the name and
checking records
Spread the mackintosh and
the towel under the site to be
punctured for IV injection.
Prepare the vein by applying
tourniquet above the vein and
ask the patient to close the
fist.
Clean the site with an
antiseptic swab at the centre
of the site.
When the needle is in the
vein ask the client to relax
the fist and remove the
tourniquet and push the
medicine slowly.
Remove the needle and put
pressure on the puncture site
with a sterile swab.
Make the patient cmfortable
and record the procedure.

To withdraw the required amount if

medicine.

To cary the prepared medicine to the

patient in a sterile container.
For safe disposal of articles.

To ensure accuracy
To allay anxiety
To prevent cross infection
To ensure accuracy: double check is
necessary before drug administration
To prevent soiling of the beds.

Distended vein creates easy insertion

of needle.
Cleaning of skin will reduce chances of
infection.
For easy smooth flow of medicine in to
the vein.

To prevent escape of blood.

To prevent error.

OBSERVATION

observe client closely for adverse reaction as drug is administered and

for several minutes thereafter.
Observe for any contraindication, i.e. swelling and discomfort etc.
Notice clients verbal and non verbal expression for the infusion.

PATIENT AND FAMILY TEACHING

Teach caregiver to apply pressure with sterile gauge if needle falls

out.
Teach the patient and family about the importance of intravenous
infusion.

INTRADERMAL INJECTION
DEFINITION- it is the administration of medication in to the dermis, below the
epidermis.
PURPOSES- to obtain local effect at the site of injection such as to test allergic
reactions of the drug.
ASSESSMENT OF THE PATIENT
Review physicians medication order.
Know information regarding expected reaction when testing skin
with specific allergen or medication.
Assess clients knowledge of purpose and reaction of skin testing.
NURSING OBJECTIVES
Develop individualized goals for the client based on nursing diagnosis.
Minimizes the discomfort of the patient.
Minimizes the clients anxiety.
PATIENT PREPARATION

Explain the procedure to the patient.

Provide privacy if needed.
Restrain the site of injection in case of children.
Possibly avoid meal times.
Keep the attention of the patient away from the injection by friendly
conversation.
Offer bad pan if client has to remain in bed for a considerable time
before, during and after the procedure.
Place patient in comfortable and relaxed position.
Select the appropriate site for injection.

EQUIPMENT- a tray containing

Disposable syringes and needles of various size according to the

need in a covered tray.

Transfer forceps in a jar containing antiseptic solution.

Sterile cotton swab and gauze pieces in sterile container.
Methylated spirit in a container
Bowl with water (as per hospital policy)
Kidney tray with paper bag
Drug ordered
Water for injection
File to cut ampoule
Small covered sterile tray
PROCEDURE

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.
1
Wash hands

STEPS

RATIONAL
Reduces transfer of microorganisms.

Close room curtain or door.

To provide privacy.

Keep linen or gown draped over

body parts not requiring exposure.

Injection site may require exposure of

body parts, to visualize the injection
site.

6
7

8
9
10
11
12

Select appropriate injection site.

Inspect skin surface over sites for
bruises, inflammation or edema.
Note lesions or discolorations of
forearm. Select site three or four
finger width below antecubital
space and hand width above wrist.
Assist the client to comfortable
position with elbow and forearm
extended and supported on flat
surface.
Apply disposable gloves.
Cleance site with an antiseptic
swab. apply swab at centre of the
site and rotate outward in a circular
direction for about 5 cm.
Hold swab between third and fourth
fin Ger of non dominant hand.
Remove needle cap or sheath from
needle by pulling it straight off.
Hold syringe between thumb and
forefinger of dominanat hand with

Injection site should be free of

abnormalities that may interfere with
drug absorption. An intra derma site
should be clear so results of skin test
can be seen and interpreted correctly.
Stabilize injection site for easiest
accessibility.
To prevent accidental exposure to blood
and body.
Mechanical action of swab removes
secretion containing microorganisms.
Swab remains readily accessible when
needle is withdrawn.
Preventing needle from touching sides
of cap thus prevents contamination.
Smooth injection requires proper
manipulation of syringe parts.
Needle pricks tight skin more easily.

13

14
15
16
17
18

19

bevel of needle pointing up.

With non dominant hand stretch
skin over site with forefinger or
thumb.
With needle almost against clients
skin insert it slowly at 5 to 15
degree angle untill resistance is
felt. Then advance needle through
epidermis to approximately 3 mm
below skin surface. Needle tip can
be seen through skin.
Inject medication slowly. Normally a
resistance is felt. If not, needle is
too deep. Remove and being again.
While injecting medication notice
that small bleb resembling
mosquito bite appears on skin
surface.
Withdraw needle while applying
alcohol swab gently over site during
needle withdrawal.
Dont massage the site.
Assist client to comfortable
position.

Ensure needle tip is in dermis.

Slow injection minimize disconfort at

site.

Bleb indicates medication is deeposited

in dermis.
support of tissue around injection site
minimizes the discomfort.
Massage may dispose medication into
underlying tissue layers and alter test
result.
Gives client sense of well being.
Prevents injury to client and health
professional. Caping of needle is risky.
Special safety shields prevents pricks.
Reduces transmission of
microorganisms.

Discard uncapped needle or needle

enclosed in safety sheid and
dispose syringe in approximately
labeled receptacles.
Remove gloves and wash hands.
OBSERVATION

Stay with client and observe for any allergic reaction.

Use skin pensil and draw circle around perimeter of injection site. Read
site within 48 to 72 hours to injection.
Ask client to discuss implication of skin testing and signs of
hypersensitivity.

RECORDING
Record amount and type of testing substance and date and time on
medication record.

 Record areas of injection and appearance of skin on nurses notes.

Report any undesirable effects from medication to nurse in charge
of physician.
PATIENT AND FAMILY TEACHING

When client is tested in a clnic or other out patient department, have them
call for follow up to ckeck the skin test results.
Explain the client the skin reactions to observe.
SUBCUTANEOUS INJECTION
DEFINITION- subcutaneous means under the skin. It is the administration
of medication in to the subcutaneous tissue by using a short needle to
inject a drug in to the tissue layer between the skin and the muscle.
Eg. Insulin
PURPOSES- slow absorption of medications.
ASSESSMENT OF THE PATIENT

Check patients name, bed no. and other identification.

Check the diagnosis and age of patient.
Check the purpose of the injection.
Check the physicians order or type of injection.
Check the consciousness of the patient.
Check the site of injection for any allergic reaction.
Check the abilities and limitations of patient.
Check the patients previous experience with injection.
Check articles available in patients unit.

NURSING OBJECTIVES
Provide privacy for the client.
Ensure the clients position is not contraindicated by medical condition.
Nurse should take special care to avoid errors in dosage calculation
and preparations.
Nurse should take care that the tissue around the needle stays nearly
normal in tension and appearance.
Select an area, which shows no signs of infection.
Check the vital signs before and after the injection.
PATIENT PREPARATION

Explain the procedure to the patient.

Provide privacy if needed.
Restrain the site of injection in case of children.

Check the vital signs and record it in nurses record.

Ask the patient to wash the hand if the condition allows.
Adjust the height of bed for comfortable working of nurse.
Place the patient in a comfortable and relaxed position suitable for
injection.
Divert the patients attention from the injection procedure.
Call for assistance if needed.

PREPARATION OF ARTICLES
1. Disposable gloves to prevent the spreading of disease.
2. Antiseptic swab - to prevent microorganisms.
3. Syringe with needle of appropriate size usually 27- 25 G, 3/8 to 5/8
inch.
4. Remove the needle cap or sheath from needle by ulling itstraight off
preveting needle from touching sides of cap and prevent
contamination.
PROCEDURE
[Link].
1

STEPS
Wash hands and apply disposable
gloves.
Close room curtain or door.

RATIONAL
Reduces transfer of microorganisms.

Keep linen or gown draped over

body parts not requiring exposure.

Proper selection of injection site may

require exposure of body parts.
Injection site should be free of lesions
that might interfere with drug
absorption.

Select appropriate injection site.

Inspect skin surface over sites for
bruises, inflammation or edema
otenderness.

In case of repeated daily injection,

rotate injection site daily.

Rotation of site prevents

subcutaneous scaring which interfere
with drug absorption.

2
3
4

Be sure needle size is correct by

grasping skin fold at site with thumb
and forefinger. Measure skin folds
from top to bottom and make sure
needle I approximately one half this
length.
Assist client to comfortable position
and to relax, arm leg or abdomen,
depending on site chosen for
injection.

To provide privacy.

Ensure that needle will lie injected in

to subcutaneous tissue.
Relaxation of area minimizes
discomfort during injecton. Promote
clients comfort.
Accurate injection of medication

10

Relocate site using anatomic

landmarks.

11
12

13

Cleanse site with antiseptic swab.

Apply swab
At centre of site and rotate outward
in circular direction from about cm.
Hold swab between third and fourth
finger of non dominant hand.
Remove needle cap sheath from
needle by pulling it straight off.
Hold syringe between thumb and
forefinger of dominant hand as if
grasping or hold syringe across top
of finger tip.

14

15

16
17
18
19

20

requires insertion in correct site to

avoid injury to underlying nerves,
bones or blood vessels.
Mechanical action of swab removes
secretion containing microorganism.
Swab remains readily, accessible for
when needle is with drawn.
Preventing nedle from touching sides
of cap prevent contamination.
Quick, smooth injection requires
proper manipulation of syringe part.

Needle penetrates the tight skin

easier than loose skin. Pinching skin
Administer injection
elevates subcutaneous tissue.
For average sizes client spread Quick, firm insertion minimizes
discomfort.
skin, tightly across injection
site or punch skin with non
Obese client have fatty layer of
dominant hand.
tissue above subcutaneous layer.
Inject needle quickly and
firmly at 45-90 degree angle.
For obese client pinch skin at
Properly performed injection requires
site and injrect needle below
smooth manipulation of syringe
tissue fold at 90 degree.
parts. Movement of syringes may
After needle enters site grasp lower
end of syringe board with non
dominant hand. Avoid moving
syringe.
Slowly pull back on plunger to
aspirate medication. If blood
appears in syringe with draw needle,
discard medication and syringe
properly and repeat procedure. If no
blood appears inject medication
slowly.
With draw needle quickly while
placing antiseptic swab gently

displace needle and cause

discomfort.
Aspiration of blood in to syringe
indicates intravenous placement of
needle subcutaneous medication are
generally not for intravenous
absorption.
supporting tissue around injection
site minimizes discomfort during
needle withdrawal.
Mssage stimulates circulation and
improves drug distribution and
absorption gives client sense of well
being.

above or over site.

Massage site lightly (except for
insulin and heparin).

Prevent injury to client and health

care personal.

Assist client of comfort position.

Reduces transmission of micro

organisms.

Discard uncapped needle or needle

enclosed in safety shield and
attached syringe in
appropriately labeled receptacle.
Remove gloves and wash hands.

OBSERVATIONS- observe client closely for any adverse reaction as drug is

administered foe several minutes there after.

Observe for any swelling or edema.

Observe whether the patient had any irritation for the injections.
Observe for any unusual pain or hardening of thet particular portion.

RECORDING- record in nurses note number of attempts for inertion, size

of needle and when it was given.

Record patients verbal and non verbal response to injection.

Record whether there was any complication.

PATIENT AND FAMILY TEAHING- teach the patient to hold the cotton swab
for some more time.
Client who require daily injections wil need to learn techniques of self
administration. A family member or a significant others should also be
taught injection technique.
Teach the family about the purppose for which the injection was given.

BIBLIOGRAPHY
The Trained Nurses Association of India, Fundamentals of nursing A procedure of
manual (2007), New Delhi, secretary general on behalf of TNAI.
Temple smith Jean, Johnsons young joyee, 1998, Nurses guide to clinical procedures,
New york, Lippincott.
Clement Nisha, 2015, principles and practice of nursing -1, nursing arts and procedures,
New Delhi, EMMESS medical publishers.
Prakash Ratan, 2007, Manipal mannual of nursing procedures, fundamentals of nursing,
Bangalore (India), CBS publishers and distributers.